Researchers found that more than 80 percent of patients had postoperative fevers. Of the patients with fever, 62 percent were given lumbar punctures, or spinal taps, to diagnose suspected bacterial meningitis. Only six of these patients were diagnosed with meningitis, and these children had also complained of headache, lethargy and wound discharge, which the majority of children with low-grade fever alone did not experience.
"This study has already been helpful to the physicians and nurses providing postoperative care for these children because it helps them anticipate which patients truly require spinal taps," said Kossoff. "A child with a low-grade fever who is active and does not exhibit other symptoms is unlikely to be infected, while a child with a high fever, headache, lethargy and actually appears ill is at perhaps higher risk."
Other factors that indicated infections included elevated white blood cell counts in the cerebrospinal fluid (CSF), very high temperatures, and prolonged use of steroids, commonly used in these patients.
As a result of this study, Children's Center doctors and nurses may allow fevers without other symptoms to persist for as long as two weeks if the child is active and playful. Of the 10 patients undergoing hemispherectomy since 2001, only one has required the insertion of a shunt to drain CSF, and none have been diagnosed with bacterial meningitis.
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Contact: Jessica Collins
jcolli31@jhmi.edu
410-516-4570
Johns Hopkins Medical Institutions
8-Nov-2002